Thursday, November 27, 2014

Unraveling of a Presidential Turkey's Sweater

Deep into the darkness peering, long I stood there, wondering, fearing,

Doubting, dreaming dreams no mortal ever dared dream before.


Edgar Allen Poe(1809-1849), The Raven

I had a sad Thanksgiving dream last night of a great unraveling.

At the center of the dream was a live gigantic, gobbling , gobbledegooking turkey lying on its back dressed in a giant multicolored sweater.

Various creatures bearing name tags had pinned the turkey down.

It was like a scene out of Gulliver Gulliver’s Travels, the Giant Insect in Kafka’s Metamorphosis, and the Headless Horseman in Washington Irving's Sleepy Hollow.

Each of the creatures was pulling out a strand of yarn from the sweater.

One bore the name tag “President,” and his piece of yarn was called “Broken Promises.”

The second name tag said “Health Plan Executive #1- Rise in Premiums.”

The third name tag read “Health Plan Executive #2 – Narrowing of Networks.”

The fourth name tag was “Overseer of Disastrous Launch.”

The fifth name tag simply said, “Gruber Obfuscation.”

The sixth name tag exclaimed, “Schumer Confession.”

The seventh name tag explained, “Excluder of Middle Class and Redistributor of Wealth.”

The eighth name tag blared, “Republicans and Midterms.”

The ninth name tag bled,”Keeper of the National Budget.”

The tenth name tag mourned, “ Tracker of Slow Growth Economy.”

Each of these Lilliputian-like creatures, who privately considered themselves Giants of the Realm, was yanking hard on their thread of yarn, and the sweater that had kept the turkey alive and warm was unraveling.

The dream ended with the turkey headless, cold, and cooked with his sweater a discarded pile of yarn.

Wednesday, November 26, 2014

HHS Downplays Healthcare.Gov Estimates

Downplay – To treat or speak of something as to reduce its importance, value, strength.

Under its new secretary, Sylvia Mathews Burwell, HHS is being modest about expectations for this second signup for healthcare.gov. It has a lot to be modest about. In the first sign-up period, it said it had signed up 7 million people, but critics have challenged that number, saying it was padded by dental plans, and 400,000 who were later found to be ineligible. Now the actual number is said to be 6.7 million.

This time around, in the 12 week November 15 to February 15 signup period, HHS is being cautious. It says it expects to enroll a total of 9.9 million, perhaps as few as 9.1 million. These would be added to 2.9 million to the original 6.7 million. This is a considerable downplay from the 15 million, the CBO originally forecast to be signed up by the end of 2015.

In the first week of this new signup period, HHS announced 222,000 new people signed on, and 200,000 signed on the first time renewed. On December 15, HHS will automatically renew those who did not renew. Many of these will find that their plans have higher premiums. HHS expects a rush of new enrollees before the December 15 deadline and the final February 15 deadline.


Let’s back off for a moment and consider the 222,000. If you multiply 222,000 times 12 weeks, it comes to 1.850, 000 million. Add that to 6. 7 million, assuming that 6.7 million pay their premiums and keep their plans, and you get 8.55 million, a modest downplay from the projected 9.9 million, now projected by some federal guessers to be closer to 9.0 million. That would be 43.0% less than 15 million, and 13.6% less than 9.9 million.

There would, however, be a 9 million dent in the 36 million uninsured when ObamaCare passed in 2010, not bad when one knows ObamaCare was to take 10 years to reach its final goal


This time around, federal officials, with the 2013 disastrous start even in mind, are being cautiously pessimistic, even humble in their predictions.

Secretary Burwell, says after this first week, healthcare.gov is off to a “solid start."One person's solidity, I suppose, is another persons' fluidity.

Maybe solid start will end with a flourish, but I am reminded of what Winston Churchill said of Clement Attlee, his successor as Prime Minster. When told Attlee was a modest man, Churchill commented, “ He has a lot to be modest about.” Modesty is not a trait usually associated with the Obama administration, but perhaps they have learned a lesson.
ObamaCare: You Can’t Outsmart the Middle Class

That which in England call the middle class in America is virtually the nation.

Matthew Arnold (1822-1888), A Word about America, 1882

America is a middle class nation. About 85% of us, 240 million, fall into that category.

When President came into office, he made a critical error. He decided to focus on the 36 million people, 12% of the population, without health insurance on the lower rungs of the economic ladder rather than those in the middle of the ladder.

Jonathon Gruber, arguably the “architect” of ObamaCare claims proponents of the health law thought they could pass it by outsmarting stupid voters in the middle class. This may be too cynical a view. The intent may have been to advance the "social good," as defined by the elite.

The middle class was not impressed. From the onset, voters in 2012 and 2014 midterms rejected the law. Today 37% favor the law while 56% oppose it.

President Obama and the Democrats may have outsmarted themselves.

In a speech at the National Press Club yesterday, Sen. Chuck Schumer (D-NY) says Democrats "blew the opportunity the American people gave them" in 2008.

"After passing the stimulus, Democrats should have continued to propose middle-class oriented programs and built on the partial success of the stimulus."

"Unfortunately, Democrats blew the opportunity the American people gave them. We took their mandate and put all of our focus on the wrong problem -- health care reform."

"The plight of uninsured Americans and the hardships caused by unfair insurance company practices certainly needed to be addressed, but it was not the change we were hired to make. Americans were crying out for the end to the recession, for better wages and more jobs, not changes in health care.”

Schumer said the focus on Obamacare was wrong because it would only affect a small portion of the electorate, concluding it was not beneficial to the Democratic party to focus on health care reform.

"The Affordable Care Act was aimed at the 36 million Americans who were not covered. "It has been reported that only a third of the uninsured are even registered to vote. In 2010 only about 40% of those registered voting. So even if the uninsured kept with the rate, which they likely did not, we would still only be talking about only 5% of the electorate."

So today, the Obama administration is faced with a middle class revolt. The law has been disastrous for the middle class – who have seen their premiums climb, their plans drop, their incomes decline, their future blighted, their hopes dashed.

It is not a pretty picture. It is why the midterm electorate voted to put Republicans back in charge of the economy. ObamaCare’s mandates, taxes, and regulations have harmed the economy and medical care of the middle class, the backbone of America.

Tuesday, November 25, 2014

Quote to Note: “No Sex, No Lies and Videotape. Gruber Saga Continues." Letters to Editor, Wall Street Journal , November 22-23, 2014.

Just as Robert Bork’s name became a verb (borked), so should Jonathon Gruber’s name become a verb meaning “lied” – “I grubered”, “He told a gruber”, “ Don’t gruber to me,” “Thou shall not gruber,” in fact. “ Gruber is a gruber.”

To these gruberisms, I would add “Romneyscare,” “Obamanation,” and “Grubergate.”
Rationing By Waiting, and Four Laws of Human Economics

All things come to those who wait.

But sometimes they come too late.


Anonymous

More people will receive care under the health law, but there will be fewer doctors to care for them. Many of these people will receive subsidies. This means health care will be rationed by waiting rather than price, for the supply of care (number of doctors) will not meet the demands of the newly insured, nor will the supply of federal monies be sufficient to meet the new costs of care.

Long waiting lists for care are common in countries with universal care. Longer waiting lists are also more common in Massachusetts, where people wait over 30 days to see a family doctor and 48 days to see an internist, even though Massachusetts has more primary care doctors per capita than any other state.

Growing waiting lists will also become the rule rather than the exception in the United States (Austin Frakt, “When Health Coverage Means Longer Waits for Doctors,” New York Times, November 24, 2014).

There are various explanations for long waites: a static or shrinking number of doctors entering primary care, the entry point for patients into the health system, more than half of existing primary care doctors are not accepting new patients; of those doctors taking on new patients, fewer still are accepting patients on health exchanges or receiving subsidies from those exchanges.

The solutions to this pervasive and growing waiting problem are : one, reduce waste and increase productivity within the system, something government is not noted for; two, increase the number of primary care physicians by paying them more or allowing nurses to substitute for primary care physicians; or three, increase the number of visas for foreign-trained primary care physicians.

All of these things take time and have controversial downsides.

According to John Goodman, a conservative economist who created and heads up the National Center for Policy Analysis in Texas, rationing by waiting has its own costs.

“What I call health policy orthodoxy is committed to the idea that waiting for care is always better that paying for care for low-income patients. In other words, if you have to ration scarce medical resources somehow, rationing by waiting is always better than rationing by price. Yet, whenever the poor and the non-poor compete for resources in almost any non-price rationing system, the poor always seem to lose out.”

They lose out because their illnesses may become worse while waiting. They lose out because doctors often do not accept them because doctors find government pricing too low and government bureaucracy too cumbersome and too time consuming.

Goodman says market-based alternatives are cutting through the rationing-by-waiting time warp: walk-in clinics, telephone and email consulting services, surgery centers, free-standing emergency centers, retail outlets, and concierge practitioners - all of whom will see patients on short notice or the day they call or need care and who ask for cash for care.

Why is rationing by waiting such a common feature of government programs? Because of certain laws of human economics.

One, the Law of Supply and Demand. When the demand for care goes up, and the supply of doctors goes down, price and costs go up, and rationing by waiting becomes inevitable.

Two, the Law of Time and Money. Time is money, and there is only so much time. Doctors, already overloaded, have limited time, so they ration care by prolonging waiting times.

Three, the Law of the Free Lunch. There are never enough doctors to meet the demands created by the promise of free care, or enough middle class taxpayers to finance those demands, so time is rationed.

Four, the Law of Competition and Cash. The only way to disrupt the Laws of Supply and Demand, Time and Money, and the Free Lunch, is through the practice of the Law of Competition and Price. People understand lower prices offered by competitors, and they understand that direct cash transactions without intervening middlemen are a visible and viable way of saving time and limiting rationing. Money talks, and lower prices offered by competitors talk even louder

Monday, November 24, 2014

Defining and Defying Reality

A leader’s role is to define reality and to give hope.

Napoleon Bonaparte (1769-1821), self-proclaimed emperor of France

Ken Chenault, CEO of Amex, the third African-American CEO of a Fortune 500 company, and Harvard Law School graduate, often quotes Napoleon’s maxim about leadership.

Chenault should pass on Napoleon’s advice to the White House.

President Obama is aggressively defining reality on his own terms. Without consulting or working with Congress, Obama has announced a climate deal with China, seeks to order more carbon-emission cuts , says he will close Guantanamo Bay, vows to veto any changes in health law mandates, raise the minimum wage for all Americans, and shield five million undocumented immigrants from deportation.

He is being petulant in defeat. He is creating a legacy that will be remembered for short-term gain, and long-term pain.

He is building a second term defined by unilateral action rather than bipartisan reality. He has struck a defiant tone about his powers to act on his own. He is inviting confrontation rather than compromising .

Exit polls after Obama’s midterm drubbing indicate compromise is what the public wants.

On ObamaCare, the Public wants the health law to be fixed and modified, not repealed. The citizenry wants the President to back off and deliver on his promises - keeping their doctors and health plans, expanding choice, lowering premiums, lowering overall costs, covering the uninsured and underinsured. He may have done the latter but not the former through massive redistribution of benefits.

In addition, the Public wants less government not more. They want economic growth, more hope for the middle class, more full-time job opportunities and less regulations, less meddling with small businesses, fewer health plan cancellations, more access to health plans and doctors of their liking.

More than anything else, they want more hope for themselves, their children, and their grandchildren.

They want a realistic, not a defiant, leader. They want a President, as defined by the Constitution, not an Emperor, as defined by Himself.